1. Preparedness and Response Strategies for Diverse and Special Populations Nora O’Brien, Principal Consultant Connect Connect Services 13 th Annual Emergency Management Higher Education Conference June 8, 2010

2. Presentation Overview Definitions of diverse and at-risk populations Definitions of diverse and at-risk populations Review of types vulnerable population providers Review of types vulnerable population providers Community health centers Community health centers Dos and don’ts for emergency management officials partnering with vulnerable populations Dos and don’ts for emergency management officials partnering with vulnerable populations Examples of preparedness and response activities: Examples of preparedness and response activities: Asian Pacific Health Care Venture- Los Angeles Asian Pacific Health Care Venture- Los Angeles So Cal Harris Fire- San Diego So Cal Harris Fire- San Diego Questions Questions June 8, 20102 13th Annual Emergency Management Higher Education Conference

3. Diverse and At-Risk Populations Definitions Public Health Services Act defines at-risk populations as: Public Health Services Act defines at-risk populations as: Children, senior citizens, and pregnant women Children, senior citizens, and pregnant women ASPR Hospital Preparedness Program FY10 guidance adds these groups to the at-risk populations definition: ASPR Hospital Preparedness Program FY10 guidance adds these groups to the at-risk populations definition: Live in institutional settings Live in institutional settings Have Limited English Proficiency (LEP) Have Limited English Proficiency (LEP) Transportation challenged, i.e. limited economic resources Transportation challenged, i.e. limited economic resources Chronic medical disorders Chronic medical disorders Have other needs that interfere with their access to receive care Have other needs that interfere with their access to receive care June 8, 20103 13th Annual Emergency Management Higher Education Conference

4. Types of Vulnerable Population Providers These providers have the trust of the populations EM officials need to reach in time of disaster Family resource centers Family resource centers Women, infant, and children (WIC) providers Women, infant, and children (WIC) providers Community centers Community centers Child care providers Child care providers Home health agencies Home health agencies Faith communities who serve diverse cultures Faith communities who serve diverse cultures Community health centers Community health centers June 8, 20104 13th Annual Emergency Management Higher Education Conference

5. Dos and Don’ts Partnering with Vulnerable Service Providers Do: Do: Invite these providers to the local disaster planning table Invite these providers to the local disaster planning table Provide preparedness resources to providers Provide preparedness resources to providers Include these key providers in your resource mapping efforts Include these key providers in your resource mapping efforts Ask them what they need to better prepare their clients/patients for disasters or emergencies Ask them what they need to better prepare their clients/patients for disasters or emergencies Identify their assets and resources (language skills, etc) that can be tapped in disaster Identify their assets and resources (language skills, etc) that can be tapped in disaster Invite them to participate in community drills and exercises Invite them to participate in community drills and exercises Know that they are plugged to other providers Know that they are plugged to other providers June 8, 20105 13th Annual Emergency Management Higher Education Conference

6. Dos and Don’ts Partnering with Vulnerable Service Providers Don’t: Don’t: Expect that these providers are well versed in EM concepts without training Expect that these providers are well versed in EM concepts without training Assume that they know whom to contact to assist their clients/patients during disaster or emergency Assume that they know whom to contact to assist their clients/patients during disaster or emergency Assume that these providers have adequate emergency supplies to effectively respond to disaster Assume that these providers have adequate emergency supplies to effectively respond to disaster Can take on extended duties (extended hours, deployment of staff, etc) during disaster without community support Can take on extended duties (extended hours, deployment of staff, etc) during disaster without community support June 8, 20106 13th Annual Emergency Management Higher Education Conference

7. Community Health Centers Overview Spread across 50 states and all U.S. territories, there are 1,250 Community Health Center (CHC) organizations that provide primary care to 20 million Americans Spread across 50 states and all U.S. territories, there are 1,250 Community Health Center (CHC) organizations that provide primary care to 20 million Americans Health centers serve the all including the homeless, residents of public housing, and migrant farm workers Health centers serve the all including the homeless, residents of public housing, and migrant farm workers Serve 20% of low-income, uninsured people Serve 20% of low-income, uninsured people 70% of CHC patients live in poverty 70% of CHC patients live in poverty 29% of patients are LEP 29% of patients are LEP Provide comprehensive care, including physical, mental and dental care Provide comprehensive care, including physical, mental and dental care June 8, 20107 13th Annual Emergency Management Higher Education Conference Source: National Association Community Health Centers

8. Community Health Centers: Preparedness and Response Asian Pacific Health Care Venture- Los Angeles Asian Pacific Health Care Venture- Los Angeles 85% of APHCV patients are monolingual in the language of their country of origin and lack health insurance. 85% of APHCV patients are monolingual in the language of their country of origin and lack health insurance. Provide language translation & ethnic specific health education in ten API languages: Bangladeshi, Cambodian, Cantonese, Mandarin, Indonesian, Japanese, Korean, Tagalog, Thai, and Vietnamese, as well as English and Spanish. Provide language translation & ethnic specific health education in ten API languages: Bangladeshi, Cambodian, Cantonese, Mandarin, Indonesian, Japanese, Korean, Tagalog, Thai, and Vietnamese, as well as English and Spanish. More than 90% of their staff are bilingual or trilingual to serve their patients and clients More than 90% of their staff are bilingual or trilingual to serve their patients and clients June 8, 2010 13th Annual Emergency Management Higher Education Conference 8

9. APHCV Disaster Preparedness Clinics are trained to: Conduct hazard vulnerability assessments Conduct hazard vulnerability assessments Prepare mitigation plans Prepare mitigation plans Develop emergency operations plans Develop emergency operations plans Conduct drills Conduct drills Utilize the federal Incident Command System (ICS) and National Incident Management System (NIMS) Utilize the federal Incident Command System (ICS) and National Incident Management System (NIMS)Incident Command System National Incident Management SystemIncident Command System National Incident Management System June 8, 20109 13th Annual Emergency Management Higher Education Conference

10. APHCV: Limited English Proficiency Services in Disaster Preparedness As part of the Incident Command System, APHCV has an Interpreting Unit Leader who appoints bilingual staff to Interpreting Unit. As part of the Incident Command System, APHCV has an Interpreting Unit Leader who appoints bilingual staff to Interpreting Unit. Interpreting Unit provides interpreter services to various units as needed. Interpreting Unit provides interpreter services to various units as needed. Interpreting Unit Leader reported status updates to ICS. Interpreting Unit Leader reported status updates to ICS. June 8, 201010 13th Annual Emergency Management Higher Education Conference

11. Photos from APHCV Functional Exercise June 8, 201011 13th Annual Emergency Management Higher Education Conference Incident Commander appoints Interpreting Unit Leader. Interpreting Unit Leader assigns Interpreting Unit members to various stations

12. Interpreting Unit members provide translation services to triage, mental health, and traffic control/patient registration units. June 8, 201012 13th Annual Emergency Management Higher Education Conference APHCV Functional Exercise

13. APHCV Lessons Learned Recommendations from Functional Exercise Assign walkie talkie channels to specific language Assign walkie talkie channels to specific language Assign back up interpreters if main interpreters not present Assign back up interpreters if main interpreters not present Provide emergency handouts in various languages Provide emergency handouts in various languages Interpreting unit members are assigned to provide interpretation as needed in the triage, treatment, mental health, and traffic/control patient registration units. Interpreting unit members are assigned to provide interpretation as needed in the triage, treatment, mental health, and traffic/control patient registration units. June 8, 201013 13th Annual Emergency Management Higher Education Conference

14. Affected 7 California Counties Affected 7 California Counties 500,000 Acres Destroyed 500,000 Acres Destroyed 3400+ Structures Destroyed/Damaged 3400+ Structures Destroyed/Damaged 9 Deaths and 85 Injuries 9 Deaths and 85 Injuries 1 Million People Evacuated 1 Million People Evacuated S.B. County – 15,219 Acres S.B. County – 15,219 Acres S.B. County – 381 Structures Destroyed S.B. County – 381 Structures Destroyed CHCs treated hundreds of patients at evacuation shelters, alternate care sites, and at health centers CHCs treated hundreds of patients at evacuation shelters, alternate care sites, and at health centers 2007 Harris So Cal Fire and CHC Response June 8, 201014 13th Annual Emergency Management Higher Education Conference

15. June 8, 201015 13th Annual Emergency Management Higher Education Conference

16. Founded in 1978 with 3 locations in San Bernardino County Founded in 1978 with 3 locations in San Bernardino County Serves Rural and Urban Populations Serves Rural and Urban Populations Primary Care Medical Services Primary Care Medical Services Obstetrics Obstetrics Dental Dental Pharmacy Pharmacy Behavioral Health Behavioral Health Substance Abuse Treatment Substance Abuse Treatment Homeless Support Services Homeless Support Services Women’s Substance Abuse Day Treatment Women’s Substance Abuse Day Treatment Prevention and Outreach Prevention and Outreach 10,647 Users with 64,000 Encounters and 89% are FPL 10,647 Users with 64,000 Encounters and 89% are FPL Inland Behavioral Health Services June 8, 201016 13th Annual Emergency Management Higher Education Conference

17. C ompromised Air Quality – Respiratory Complaints C ompromised Air Quality – Respiratory Complaints Major Thoroughfare Closures Major Thoroughfare Closures Behavioral Needs – PTSD issues related to fire Behavioral Needs – PTSD issues related to fire New Patient Surge New Patient Surge Patient Population Unable to Access Care Patient Population Unable to Access Care IBHC Fire Response: What They Faced June 8, 201017 13th Annual Emergency Management Higher Education Conference

18. Not prepared for patient surge Not prepared for patient surge Decreased staffing due to school closures, evacuations, and road closures Decreased staffing due to school closures, evacuations, and road closures Decreased staffing due to call for volunteers at evacuation shelters Decreased staffing due to call for volunteers at evacuation shelters Inadequate supplies Inadequate supplies Decreased capacity at area hospitals Decreased capacity at area hospitals Lack of communication at the local level Lack of communication at the local level IBHS: Response Challenges June 8, 201018 13th Annual Emergency Management Higher Education Conference

19. Communication on Local Level is Paramount Communication on Local Level is Paramount EOP Needs to Be Reviewed and Updated Annually EOP Needs to Be Reviewed and Updated Annually Consider Staffing Alternatives Consider Staffing Alternatives Identify Alternative Supply Resources Identify Alternative Supply Resources Disaster Preparedness Practice is Key! Disaster Preparedness Practice is Key! IBHS Response: Lessons Learned June 8, 201019 13th Annual Emergency Management Higher Education Conference

20. Closing Thoughts Vulnerable service providers such as CHCs can offer valuable access to communities and populations that EM officials need to reach out to during disaster Vulnerable service providers such as CHCs can offer valuable access to communities and populations that EM officials need to reach out to during disaster When vulnerable service providers and EM officials work closely to prepare for disaster, communities can become more resilient. When vulnerable service providers and EM officials work closely to prepare for disaster, communities can become more resilient. June 8, 2010 13th Annual Emergency Management Higher Education Conference 20

21. Questions? Please contact: Nora O’Brien, MPA Principal Consultant Connect Consulting Services 1104 Corporate Way, Sacramento, CA 95831 Direct: 916 806-7361 NoraOBrien@me.com www.ConnectConsultingServices.com 21June 8, 2010 13th Annual Emergency Management Higher Education Conference